This study was designed to evaluate the implementation of the Nurse Education and Support Team (NEST) Program for postpartum women who reside in 5 rural counties in North Carolina. Overarching Hypothesis: Mothers and infants residing in rural communities, randomized to the NEST-Rural care model over the 3-year course of the project will: 1. Receive more coordinated care for addressing social, mental and physical health needs. 2. Experience fewer postpartum hospital readmissions and decreased utilization of emergency departments (ED) for healthcare. 3. Experience higher adherence to American College of Obstetricians and Gynecologists (ACOG) and American Academy of Pediatrics (AAP) guidelines for preventive care, including recently updated ongoing postpartum care, serial well-child visits and vaccinations compared to those assigned to usual care. This group will be compared to those assigned to usual care,
Women that deliver an infant(s) at The Birth Center at Atrium Health Wake Forest Baptist and currently reside in Davidson, Davie, Stokes, Wilkes or Yadkin County in North Carolina
Women that delivered an infant(s) at home, were transported to Atrium Health Wake Forest Baptist and received postpartum care at The Birth Center and currently reside in Davidson, Davie, Stokes, Wilkes or Yadkin County in North Carolina
Ages 18 years or older
Women that delivered an infant(s) and did not receive postpartum care at The Birth Center at Atrium Health Wake Forest Baptist.
Women that currently reside outside of Davidson, Davie, Stokes, Wilkes or Yadkin County in North Carolina
Under 18 years of age
Parallel
Postpartum NEST-Rural Program (Hospital based service model)
Other interventionNEST-Rural services will include 3-5 nurse encounters and, if indicated, up to 3 social work encounters with mothers and their infants in the postpartum period, postpartum remote blood pressure monitoring, breastfeeding support, infant weight checks, linking mothers and infants to needed social, behavioral, and health-related resources, and integration of service delivery with healthcare providers.
Median number of hospital readmissions - Maternal
Number of hospital readmissions in the 4th trimester
Median number of hospital readmissions - Maternal
Number of hospital readmissions in the 4th trimester
Median number of encounters for urgent or emergent care - Maternal
Number of visits to Urgent Care or the Emergency Room in the 4th trimester
Median number of encounters for urgent or emergent care - Maternal
To determine number of visits to Urgent Care or the Emergency Room in the 4th trimester
Median number of days with >/= 1 remote blood pressure obtained - Maternal
Number of days that patients checked and remotely reported their blood pressure readings following hospital discharge.
Proportion of women with a diagnosis of hypertensive disorders of pregnancy with at least one blood pressure obtained
Percentage of women diagnosed with hypertensive disorders that checked and remotely reported at least one blood pressure reading.
Proportion of women with preeclampsia with severe features with at least one blood pressure obtained
Percentage of women with preeclampsia with severe features checked and remotely reported at least one blood pressure reading.
Proportion of women exceeding 3 days length of stay in hospital after delivery
Percentage of women that remain hospitalized for more than 3 days following delivery.
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Wake Forest University Health Sciences
Lead sponsor
The Duke Endowment
Collaborator
